Hemorrhoids are swollen veins located in the lower rectum and anus. These vascular cushions are present in all individuals, but they only become symptomatic when they swell and become inflamed. This article clarifies the typical location of hemorrhoid pain and explains the mechanisms that can cause the sensation of pain spreading to nearby regions.
Where Hemorrhoid Pain Is Typically Felt
The location and intensity of discomfort depend significantly on the type of hemorrhoid involved. Internal hemorrhoids form inside the rectum, an area with few somatic pain receptors, so they often result in painless bleeding. Pain only occurs when an internal hemorrhoid prolapses, or bulges out of the anus, where it can become irritated or strangulated.
External hemorrhoids, which develop under the highly sensitive skin surrounding the anal opening, are the primary source of true pain. Sensations may include pressure, discomfort, or a sharp, throbbing ache, particularly when sitting or during a bowel movement. The most intense pain occurs when a blood clot forms within an external hemorrhoid, creating a thrombosed hemorrhoid, which stretches the surrounding nerve-rich tissue.
Understanding Perceived Pain Spread
True nerve radiation, like the pain that travels down the leg with sciatica, is not a typical characteristic of hemorrhoid discomfort. However, the localized pain can be intensely felt in adjacent structures, leading to a perception that the pain has spread. This sensation of spreading or deep aching often extends to the buttocks, tailbone, or sacrum area.
This perceived spread is often related to muscle tension and referred pain within the pelvic floor. The intense irritation from a hemorrhoid can cause the surrounding sphincter and levator ani muscles to involuntarily tighten or spasm. Since these pelvic floor muscles connect the anus, rectum, and the coccyx, tension or spasm is perceived as a deep, aching discomfort in the lower pelvis or tailbone area.
Hemorrhoids, particularly large or prolapsed ones, can physically exert pressure on surrounding tissues, including the attachment points of the levator muscles near the tailbone. When inflamed tissue pulls on these muscles, it can result in coccyx pain, or coccydynia. Additionally, changes in posture while sitting to avoid direct pressure on the hemorrhoid can cause secondary muscle strain in the lower back and upper thighs.
Signs That Pain Is Not Hemorrhoid Related
While hemorrhoid pain can manifest as deep, widespread pelvic discomfort, certain symptoms suggest the pain is caused by a different or more urgent condition. Pain that is sharp, cutting, and lingers for hours after a bowel movement may indicate an anal fissure. Hemorrhoid pain is typically a more constant pressure or throbbing ache that is less related to the act of defecation.
Other warning signs include severe, constant, throbbing pain accompanied by a fever or chills, which suggests a potential perianal abscess or fistula. Pain that radiates down the leg below the buttocks, along with numbness or tingling, points toward a nerve compression issue unrelated to the hemorrhoids. If you experience pain that is distant from the anal area, is debilitating, or is accompanied by systemic symptoms, seek consultation with a healthcare provider for an accurate diagnosis.